Provider Demographics
NPI:1639441520
Name:KIMBROUGH, CINAMON K (LAC, LMT)
Entity Type:Individual
Prefix:MS
First Name:CINAMON
Middle Name:K
Last Name:KIMBROUGH
Suffix:
Gender:F
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10002 N 7TH ST APT 1106
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-1755
Mailing Address - Country:US
Mailing Address - Phone:815-701-1259
Mailing Address - Fax:
Practice Address - Street 1:10304 N HAYDEN RD STE 100
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-1218
Practice Address - Country:US
Practice Address - Phone:815-701-1259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-07
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-20576225700000X
AZ010012171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist